The present invention relates to medical devices for performing surgery and to surgical repair kits containing the same. More particularly, the present invention is directed to a surgical repair kit useful for transporting suture during arthroscopic rotator cuff repairs, arthroscopic shoulder stabilization surgeries, arthroscopic meniscal repairs and other surgical procedures.
A group of four muscles around the shoulder joint is called the rotator muscles of the shoulder. The tendonous portions of those muscles that insert into the bony tuberosities of the humeral head are known as the rotator cuffs. The rotator cuffs are frequently torn at, or close to, the point of bony insertion due to trauma or due to degenerative changes frequently associated with aging. Weakness and pain are common indications for the surgical repair of rotator cuffs. The surgical procedure consists of the reattachment of the rotator cuff to its bony bed.
Another type of tear in the shoulder that frequently requires surgical intervention relates to instability of the shoulder joint after the shoulder has been previously dislocated. This instability is commonly the result of a tearing of the joint capsule and its labrum (a fibrocartilaginous structure) from the anterior aspect of the glenoid. This deficiency is commonly referred to as a Bankart lesion. One procedure for correcting the instability associated with a Bankart lesion is to reattach the torn capsule and labrum to bone on the anterior aspect of the glenoid.
Both of the aforementioned procedures, as well as many others, involve the reattachment of soft tissue to bone.
The widespread adoption of the arthroscope has made it possible for the surgeon to visualize the interior of the joint and to perform surgery through small puncture holes without having to lay open the joint as was previously necessary. In addition, the advent of suture anchors, and associated instrumentation, has made it possible for surgeons skilled in arthroscopy to perform the two aforementioned procedures, and others, arthroscopically.
Other arthroscopic procedures include the repair of the meniscus, such as is disclosed in U.S. Pat. No. 5,776,151, issued Jul. 7, 1998 to Kwan-Ho Chan for SURGICAL REPAIR KIT AND ITS METHOD OF USE, which patent is hereby incorporated herein by reference.
The basic steps in arthroscopic rotator cuff repair and in arthroscopic Bankart repair involve:
(1) embedding a suture anchor in a bony bed;
(2) passing a suture (attached to the embedded suture anchor) through the soft tissue which is to be reattached to the bony bed; and
(3) tying the soft tissue to the suture anchor, thus coapting the torn tissue to the bony bed.
At other times, torn or lax tissues are repaired or tightened by passing sutures through two points in the soft tissue and then tying them together.
A number of surgical instruments have been developed to assist in suturing in general and, in particular, in the suturing of soft tissue arthroscopically.
One such surgical instrument, sometimes referred to as a suture passer, comprises a hollow needle for penetrating tissue. One such suture passer is disclosed in the aforementioned U.S. Pat. No. 5,776,151, which has already been incorporated herein by reference. Another such suture passer is disclosed in pending U.S. patent application Ser. No. 09/400,162, filed Sep. 21, 1999 by Kwan-Ho Chan for SURGICAL REPAIR KIT AND ITS METHOD OF USE, which patent application is hereby incorporated herein by reference.
In use, the hollow needle of the suture passer is advanced through the soft tissue; suture is then advanced through the hollow needle and hence through the soft tissue. To advance the suture through the hollow needle, the suture is pushed forward from the proximal end of the instrument.
This technique generally works well where the suture comprises a relatively stiff element, e.g., monofilament suture. However, where the suture comprises a relatively limp element, such as braided suture, the suture will tend to buckle when the surgeon attempts to push it forward.
Thus, when using a suture passer of the type described above, monofilament suture is typically the suture of choice, since such suture can be pushed forward without excessive buckling.
However, at times it may be desirable to use a braided suture such as Ethibond(trademark) suture, because of certain attributes of the suture material (such as superior knot security, the non-absorble nature of the material, etc.). Unfortunately, this is currently not possible with suture passers of the type described above.
Therefore, the need exists for an improved method and apparatus for passing braided suture and the like through a suture passer.
In accordance with the present invention, there is provided an improved method and apparatus for advancing braided suture through a suture passer. In one preferred embodiment, the invention comprises a suture relay that can be advanced, by pushing, through the suture passer and which is adapted to carry a braided suture across the tissue.